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Reliability and validity of the Italian version of the Chronic Pain Grade questionnaire in patients with musculoskeletal disorders

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Abstract

The aim of this study is to analyse the psychometric properties of the Italian version of the Chronic Pain Grade (CPG) questionnaire within a population of chronic musculoskeletal pain patients. The CPG questionnaire was adapted following the translation and back-translation methodologies. There were 576 patients with chronic musculoskeletal pain. Internal consistency was checked by the Cronbach’s alpha coefficient. Construct validity was analysed by performing principal component factor analysis and by comparing CPG dimensions and subscales with the SF-36 questionnaire. Discriminant validity was assessed by comparing the CPG and SF-36 dimensions in patients with and without other health conditions. Factor analysis yielded two factors which accounted for 76.4% of the variance of the questionnaire. Both subscales of the CPG showed satisfying to good internal consistency. Cronbach’s alpha was 0.89 for the first factor ‘Disability Score’ (58.72% of the explained variance) and 0.81 for the second factor ‘Characteristic Pain Intensity’ (17.70% of the explained variance). Item–total correlations for the subscales were moderate up to high (from 0.500 to 0.771). In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Discriminant validity, assessed by comparing the CPG dimensions in patients with and without other health conditions, showed that the CPG shows moderate association with the presence of co-morbidities. Furthermore, the CPG Disability Score was inversely correlated (p=0.01) to years of formal education. In conclusion, the Italian version of the CPG questionnaire has shown to be valid and reliable for evaluating the severity of chronic musculoskeletal pain, with metric properties in agreement with the original, widely used version.

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References

  1. Woolf AD, Zeidler H, Haglund U, Carr AJ, Chaussade S, Cucinotta D et al (2004) Musculoskeletal pain in Europe: its impact and a comparison of population and medical perceptions of treatment in eight European countries. Ann Rheum Dis 63:342–347

    Article  PubMed  CAS  Google Scholar 

  2. Bingefors K, Isacson D (2004) Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain—a gender perspective. Eur J Pain 8:435–450

    Article  PubMed  Google Scholar 

  3. Leardini G, Salaffi F, Caporali R, Rovati L, Canesi B, Montanelli R, and the Italian Group for Study of the Costs of Arthritis (GISCA) (2004) Direct and indirect costs of osteoarthritis of the knee. Clin Exp Rheumatol 22:699–706

    PubMed  CAS  Google Scholar 

  4. Leardini G, Salaffi F, Montanelli M, Gertzeli S, Canesi B (2002) A multicenter cost-of-illness study on rheumatoid arthritis in Italy. Clin Exp Rheumatol 20:505–515

    PubMed  CAS  Google Scholar 

  5. Smith BH, Elliott AM, Chambers WA, Smith WC, Hannaford PC, Penny K (2001) The impact of chronic pain in the community. Fam Pract 18:292–299

    Article  PubMed  CAS  Google Scholar 

  6. Lamé IE, Peters ML, Vlaeyen JWS, Kleef MV, Patijn J (2005) Quality of life in chronic pain is more associated with beliefs about pain, than pain intensity. Eur J Pain 9:15–24

    Article  PubMed  Google Scholar 

  7. Franchignoni F, Salaffi F (2004) Generic and specific measures for outcome assessment in orthopaedic and rheumatologic rehabilitation. In: Barat M, Franchignoni F (eds) Assessment in physical medicine and rehabilitation—advances in rehabilitation, vol 16. pp 45–77

  8. Keystone EC, Shiff MH, Kremer JM, Kafka S, Lovy M, De Vries T et al (2004) Once-weekly administration of 50 mg etanercept in patients with active rheumatoid arthritis. Arthritis Rheum 50:353–363

    Article  PubMed  CAS  Google Scholar 

  9. Brandt J, Listing J, Haibel H, Sorensen H, Schwebig A, Rudwaleit M et al (2005) Long-term efficacy and safety of etanercept after readministration in patients with active ankylosing spondylitis. Rheumatology (Oxford) 44(3):342–348

    Article  CAS  Google Scholar 

  10. Mease PJ, Kivitz AJ, Burch FX, Siegel EL, Cohen SB, Ory P et al (2004) Etanercept treatment of psoriatic arthritis. Arthritis Rheum 50:2264–2272

    Article  PubMed  CAS  Google Scholar 

  11. Pope JE, Prashker M, Anderson J (2004) The efficacy and cost effectiveness of N of 1 studies with diclofenac compared to standard treatment with nonsteroidal antiinflammatory drugs in osteoarthritis. J Rheumatol 31(1):140–149

    PubMed  Google Scholar 

  12. Gowans SE, Dehueck A, Voss S, Silaj A, Abbey SE (2004) Six-month and one-year followup of 23 weeks of aerobic exercise for individuals with fibromyalgia. Arthritis Rheum 51(6):890–898

    Article  PubMed  CAS  Google Scholar 

  13. Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB et al (2003) Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain 106:337–345

    Article  PubMed  Google Scholar 

  14. Von Korff M, Ormel J, Keefe F, Dworkin SF (1992) Grading the severity of chronic pain. Pain 50:133–149

    Article  Google Scholar 

  15. Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J et al (1997) The Chronic Pain Grade questionnaire: validation and reliability in postal research. Pain 71:141–147

    Article  PubMed  CAS  Google Scholar 

  16. Elliott AM, Smith BH, Smith WC, Chambers WA (2000) Changes in chronic pain severity over time: the Chronic Pain Grade as a valid measure. Pain 88:303–308

    Article  PubMed  CAS  Google Scholar 

  17. Elliott A, Smith BH, Hannaford PC, Smith WC, Chambers WA (2002) Assessing change in chronic pain severity: the Chronic Pain Grade compared with retrospective perceptions. Br J Gen Pract 52:269–274

    PubMed  Google Scholar 

  18. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  PubMed  CAS  Google Scholar 

  19. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25(11):1271–1277

    Article  PubMed  CAS  Google Scholar 

  20. Subcommittee for Scleroderma Criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee (1980) Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 23:581–590

    Article  Google Scholar 

  21. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A et al (1991) The European spondylarthropathy study group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227

    Article  PubMed  CAS  Google Scholar 

  22. Vitali C, Bombardieri S, Moutsopoulos HM, Balestrieri G, Bencivelli W, Berstein RM et al (1993) Preliminary criteria for the classification of Sjögren’s syndrome: results of a prospective concerted action supported by the European Community. Arthritis Rheum 36:340–347

    Article  PubMed  CAS  Google Scholar 

  23. Moll JMH, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3:55–78

    Article  PubMed  CAS  Google Scholar 

  24. Bird HA, Esselinckx W, Dixon AS, Mowat AG, Wood PH (1979) An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis 38:434–439

    Article  PubMed  CAS  Google Scholar 

  25. McCarty DJ (1993) Calcium pyrophosphate dihydrate crystal deposition disease. In: Schumacher HR Jr (ed) Primer on the rheumatic diseases, 10th edn. Arthritis Foundation, Atlanta, pp 219–222

    Google Scholar 

  26. Sieper J, Rudwaleit M, Braun J, van der Heijde D (2002) Diagnosing reactive arthritis. Role of clinical setting in the value of serologic and microbiologic assay. Arthritis Rheum 46:319–327

    Article  PubMed  Google Scholar 

  27. Bodolay E, Csiki Z, Szekanecz Z, Ben T, Kiss E, Zeher M et al (2003) Five-year follow-up of 665 Hungarian patients with Undifferentiated Connective Tissue Disease (UCTD). Clin Exp Rheumatol 21:313–320

    PubMed  CAS  Google Scholar 

  28. Altman RD, Asch E, Bloch DA, Bole G, Borenstein D, Brandt K et al (1986) Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 29:1039–1049

    Article  PubMed  CAS  Google Scholar 

  29. Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K et al (1990) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 33:1601–1610

    Article  PubMed  CAS  Google Scholar 

  30. Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K et al (1991) The American College of Rheumatology criteria for the classification of osteoarthritis of the hip. Arthritis Rheum 34:505–514

    Article  PubMed  CAS  Google Scholar 

  31. Frank JW, Kerr MS, Brooker AS, DeMaio SE, Maetzel A, Shannon HS et al (1996) Disability resulting from occupational low back pain: I. What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine 21:2908–2917

    Article  PubMed  CAS  Google Scholar 

  32. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosèn I (1999) Prevalence of carpal tunnel syndrome in a general population. JAMA 281:153–158

    Article  Google Scholar 

  33. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33:160–172

    Article  PubMed  CAS  Google Scholar 

  34. Ware J, Sherbourne CD (1992) The MOS 36-item short form health survey (SF-36). 1. Conceptual frame-work and item selection. Med Care 30:473–481

    Article  PubMed  Google Scholar 

  35. Apolone G, Mosconi P (1998) The Italian SF-36 Health Survey: translation, validation and norming. J Clin Epidemiol 51:1025–1036

    Article  PubMed  CAS  Google Scholar 

  36. Ware J, Kosinski M, Bayliss M, Rogers WH, Razec A (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the medical outcomes study. Med Care 4:AS264–AS279

    Google Scholar 

  37. Steiner GL, Norman DR (1996) Health measurement scales: a practical guide to their development and use, 2nd edn. Oxford University Press, Oxford

    Google Scholar 

  38. Klasen BW, Hallner D, Shaub C, Willburger R, Hasenbring M (2004) Validation and reliability of the German version of the Chronic Pain Grade questionnaire in primary care back pain patients. Psycho-Social-Medicine, 1:doc07. Available online at http://www.egms.de/en/journals/psm/2004–1/psm000007.shtml

  39. Bergman S, Jacobsson LTH, Herrström P, Petersson I (2004) Health status as measured by SF-36 reflects changes and predicts outcome in chronic musculoskeletal pain: a 3-year follow up study in the general population. Pain 108:115–123

    Article  PubMed  Google Scholar 

  40. Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA (1999) The epidemiology of chronic pain in the community. Lancet 354:1248–1252

    Article  PubMed  CAS  Google Scholar 

  41. Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ (2001) Chronic pain in Australia: a prevalence study. Pain 89:127–134

    Article  PubMed  CAS  Google Scholar 

  42. McBeth J, Macfarlane GJ, Hunt IM, Silman AJ (2001) Risk factors for persistent chronic widespread pain: a community-based study. Rheumatology 40:95–101

    Article  PubMed  CAS  Google Scholar 

  43. Rustøen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C (2004) Prevalence and characteristics of chronic pain in the general Norwegian population. Eur J Pain 8:555–565

    Article  PubMed  Google Scholar 

  44. Gagliese L, Melzack R (1997) Chronic pain in elderly people. Pain 70:3–14

    Article  PubMed  CAS  Google Scholar 

  45. Callahan LF, Smith WJ, Pincus T (1989) Self-report questionnaires in five rheumatic diseases. Arthritis Care Res 2:122–131

    Article  PubMed  CAS  Google Scholar 

  46. Goubert L, Crombez G, De Bourdeaudhuij I (2004) Low back pain, disability and back pain myths in a community sample: prevalence and interrelationships. Eur J Pain 8:385–394

    Article  PubMed  Google Scholar 

  47. Von Korff M, Dworkin SF, Le Resche L (1990) Graded chronic pain status: an epidemiologic evaluation. Pain 40:279–291

    Article  Google Scholar 

  48. Salaffi F, Leardini G, Canesi B, Mannoni A, Fioravanti A, Caporali R, on behalf of Gonarthrosis and Quality Of Life Assessment (GOQOLA) Study Group (2003a) Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index in Italian patients with osteoarthritis of the knee. Osteoarthritis Cartilage 11:551–560

    Article  PubMed  CAS  Google Scholar 

  49. Salaffi F, Piva S, Barreca C, Cacace E, Ciancio G, Leardini G, on behalf of Gonarthrosis and Quality of Life (GOQUOLA) Study Group (2000) Validation of an Italian version of the arthritis impact measurement scales 2 (ITALIAN-AIMS2) for patients with osteoarthritis of the knee. Rheumatology 39:720–726

    Article  PubMed  CAS  Google Scholar 

  50. Bombardier C, Melfi CA, Paul J, Green R, Hawker G, Wright J et al (1995) Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery. Med Care 33:AS131–AS144

    PubMed  CAS  Google Scholar 

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Acknowledgements

We acknowledge the inestimable help of council authorities, the full members of the MAPPING study and the GP of the cities involved in the study. This study was supported partly through an unrestricted educational grant from Pfizer, Italy. Pfzier has neither provided funding to authors for preparation of the manuscript nor has Pfzier influenced the manuscript content. The full members of the MAPPING study given in alphabetical order are as follows: P. Blasetti, D. Brecciaroli, M. Carotti, A. Cerioni, A. Ciapetti, A. Farina, E. Filippucci, R. De Angelis, P. Del Medico, G. Garofalo, S. Gasparini, W. Grassi, M. Gutierrez, F. Salaffi, C.A. Silvestri, S. Scalini, A. Stancati.

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Authors and Affiliations

  1. Dipartimento di Patologia Molecolare e Terapie Innovative, Cattedra di Reumatologia-Università Politecnica delle Marche, Ospedale A. Murri, Via dei Colli, 52, 60035, Jesi Ancona, Italy

    Fausto Salaffi, Andrea Stancati & Walter Grassi

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  1. Fausto Salaffi
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  2. Andrea Stancati
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  3. Walter Grassi
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Correspondence to Fausto Salaffi.

Appendices

Appendix

Italian version of the Chronic Pain Grade (CPG) questionnaire

Intensità del dolore

1
figure a

Indichi con una crocetta sulla scala graduata rappresentata di seguito (dove “0” corrisponde all’assenza di dolore e “10” al più forte dolore immaginabile), l’intensità del dolore che Lei avverte in questo momento.

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figure b

Nel corso degli ultimi 6 mesi quale è stata l’intensità del Suo peggior dolore?

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figure c

Indichi con una crocetta sulla scala graduata rappresentata di seguito (dove “0” corrisponde all’assenza di dolore e “10” al più forte dolore immaginabile), l’intensità del dolore che ha avvertito, in media, nel corso degli ultimi 6 mesi.

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Disabilità

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figure d

Indichi nella casella sottostante, il numero di giorni nel corso degli ultimi 6 mesi nei quali il dolore Le ha impedito di svolgere le sue abituali attività (scuola, lavoro retribuito, lavori domestici)

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5
figure e

Indichi con una crocetta in che misura, nel corso degli ultimi 6 mesi, il dolore ha interferito con lo svolgimento delle sue attività quotidiane

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figure f

Indichi con una crocetta in che misura, nel corso degli ultimi 6 mesi, il dolore ha interferito con le sue attività attività sociali, con la famiglia, gli amici, i vicini di casa, i gruppi di cui fa parte

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7
figure g

Indichi con una crocetta in che misura, nel corso degli ultimi 6 mesi, il dolore ha interferito con le sua capacità di lavorare (lavoro retribuito o lavori domestici)

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Take home messages

  1. 1.

    Pain is the most prominent symptom in people with musculoskeletal disorders and the most common reason for patients to seek medical help.

  2. 2.

    The severity of chronic pain, because of its intrinsic subjective nature, is still difficult to assess. Nonetheless, several useful tools have demonstrated to be useful for this purpose in the context of primary care.

  3. 3.

    The Italian version of the CPG questionnaire has been shown to be valid and reliable for evaluating the severity of chronic musculoskeletal pain.

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Salaffi, F., Stancati, A. & Grassi, W. Reliability and validity of the Italian version of the Chronic Pain Grade questionnaire in patients with musculoskeletal disorders. Clin Rheumatol 25, 619–631 (2006). https://doi.org/10.1007/s10067-005-0140-y

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  • DOI: https://doi.org/10.1007/s10067-005-0140-y

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